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Sunday, June 12, 2016

I recently talked
for an hour or so to a friend who knows that I know a lot about Type 2
Diabetes. He sought me out to ask me what he should do. I asked him, “What is
your situation?” Here’s what he told me:

His fasting blood
sugars (FBG), he said, are consistently running in the 140s. That’s 140mg/dl. I
told him that was “out of control.” I asked him what his postprandials were. He
didn’t know “postprandial” so I said your blood sugar 1 or 2 hours after
starting breakfast. He said he didn’t know. He didn’t do postprandials.

I asked him what
his latest A1c was. He replied 6.9. That’s 6.9%, but he said it was almost 2
years ago. I asked him if his doctor had told him that he was diabetic. He said
“No,” and I said, “Well, you are!” The American College of Endocrinologists
define Type 2 Diabetes as an A1c of ≥6.5%, and the American Diabetes
Association as ≥7.0%, but that definition is part of the problem. Some
clinicians today regard an A1c of ≥5.7% as full-blown Type 2 diabetes.

I asked my friend
if he was currently taking any medications to control his blood sugar. He said,
“Yes.” He was taking two 500 mg tablets of metformin twice a day, plus
glyburide (a sulfonylurea). He didn’t remember how much, and I don’t remember
how often he takes it, because this set me off on a rant.

I said, “You are
already maxed out on metformin” at 2000 mg/day, and you are taking a
sulfonylurea (SU), a class of medications that pumps the pancreas to produce
insulin to cover the carbs you are eating, AND IT’S NOT ENOUGH!” SUs ARE A DRUG
THAT, WHILE STILL PRESCRIBED BY UNKNOWING PHYSICIANS (BECAUSE ITS CHEAP AND
“EFFECTIVE” IN REGULATING BLOOD SUGAR BY SECRETING INSULIN), BEAT UP AND WEAR OUT THE BETA CELLS IN THE PANCREAS THAT MAKE THE
INSULIN, AND THEY EVENTUALLY DIE!!! RESULT: YOU WILL SOON BE TAKING BOTH
LONG ACTING AND MEALTIME INSULIN (INJECTING IT) TO CONTROL YOUR BLOOD SUGAR.

He said, “What
should I do?” I didn’t hesitate to tell him: “You’ve got to change what you
eat, I mean seriously change what you eat.” “What do you have for
breakfast,” I asked? “Oatmeal,” he said, “with milk and a little sugar.”
“Switch to eggs,” I said, “any way (fried, scrambled, poached).” “How many”, he
asked? “One, two or three; add a strip of bacon if you like,” I said, “but no
juice, cereal, bread or jelly. Only heavy cream and artificial sweetener in
your coffee, if you must.” I told him he wouldn’t be hungry. He wouldn’t need a
mid-morning snack. (He had mentioned he ate an apple in mid-morning “’cause he
was starving.” I just rolled my eyes in horror.)

I also told my
friend that he had to get off the SU. But the effect could be that his A1c will
go up unless he instead replaces it with a drug that acts in a different way,
sparing the pancreas. There are now several more modern classes of drugs, both
oral and injectable (not insulin). Many clinicians would even argue reasonably
that a temporary course of exogenous insulin would perhaps be the best course
of treatment in his case to get his blood sugar under “good control.” But I
would argue that the best course of “treatment,” and the only one that
addresses the cause of Type 2 Diabetes (which is Insulin Resistance), is to radically
change what you eat, NOW.

My own experience
supports this course of action. In 2002 I weighed 375 pounds and I was maxed
out on metformin and a sulfonylurea and starting a DPP-4 inhibitor (Avandia).
In retrospect, I was on my way to injecting insulin. My doctor wanted me to
lose weight, of course, so he
“prescribed” a radical change of diet, a Very Low Carb diet called
Atkins Induction. The surprising result was that on the 1st day of
strict compliance I got a hypo (a low blood sugar). The doc ordered me to stop
the Avandia. The next day, another hypo, and he told me to cut the metformin
and the glyburide (the SU) in half. A
few days later I had to cut them in half
again. Still later I cut out the SU altogether. Eventually, I transitioned
to Dr. Richard K Bernstein’s 6-12-12 program for diabetics.

After a few years or eating this entirelydifferent way, I had lost 170 pounds, my blood pressure was 110/70
(on the same meds), my HDL-C more than doubled and my triglycerides dropped by
2/3rds. And all I did was change what I ate.

4 comments:

I don't know what to tell you, Fred. It's been so many years since I first went LC (VLC actually), that I can't remember how long it took my body to realize that my "supply" of carbs had been cut off, and to switch to fat burning. I had a lot of fat to burn, but everyone has some. I have only the many books and articles I have read to rely on now, but the most recent I remember said that the body produces ketones, a byproduct of fatty acid catabolism (breakdown), within 24 to 48 hours. Think about this: during the night, after your dinner is completely digested and absorbed, if you have very little stored glycogen in the liver, it will make essential glucose via gluconeogenesis from amino acids but feed the other needs while you sleep with ketones.If the body is thus "fed," it will not send you a hunger signal. That's the theory, anyway. Just hang in there for a few days and DON'T EAT CARBS. That will just start the cycle of "fed and fasting" all over again.

About Me

I was diagnosed a Type 2 diabetic in 1986. I started a Very Low Carb diet (Atkins Induction) in 2002 to lose weight. I didn’t realize at the time that it would put my diabetes in clinical remission, or that I would be able to give up almost all of my oral diabetes meds. I also didn’t understand that, as I lost weight and continued to eat Very Low Carb, my blood lipids would dramatically improve (doubling my HDL and cutting my triglycerides by 2/3rds) and that my blood pressure would drop from 130/90 to 110/70 on the same meds.
Over the years I changed from Atkins to the Bernstein Diet (designed for diabetics) and, altogether lost 170 pounds. I later regained some and then lost some. As long as I eat Very Low Carb, I am not hungry and I have lots of energy. And I no longer have any of the indications of Metabolic Syndrome.
My goal, as long as I have excess body fat, is to remain continuously in a ketogenic state, both for blood glucose regulation and continued weight loss. I expect that this regimen will continue to provide the benefits of reduced systemic inflammation, improved blood lipids and lower blood pressure as well.